Introduction

Stress in the workplace is ubiquitous in all occupation groups, and chronic stress could ultimately culminate in burnout. Due to the prevalence of burnout and its effect on economies, the World Health Organization has included this syndrome as an exclusively occupational phenomenon in the 11th Revision of the Classification of Diseases (ICD-11).⁽¹⁾

A recent Women @ Work Report by Deloitte⁽²⁾ found that burnout levels have gradually reduced from nearly half of women in 2022 to a quarter of women in 2024, which may be attributable to an increased focus on corporate mental health in the pandemic and post-pandemic years. However, half of the survey respondents reported that their stress levels had increased over the past year. Half also reported being concerned about their mental health, while a third took time off from work due to mental health challenges. While stress in the workplace is ubiquitous, the effects thereof on men and women differ. This article takes a look at the nature of stress, types of stress, and the effects of prolonged stress on women.

What is stress?

The World Health Organization⁽³⁾ defines stress as “a state of worry or mental tension caused by a difficult situation”. Stress is a natural human response to stressors, and takes two broad forms — eustress and distress. Eustress is beneficial or ‘healthy’ stress, associated with a sense of fulfillment and achievement. It acts as a motivating force that helps us deal with challenges, adjust to new situations, and grow. Usually, stress reduces over time as the stressor dissipates, or as the individual learns to cope with the situation. However, when the intensity and frequency of stressors become overwhelming and last for extended periods, the result may be distress, which manifests in physical, emotional, cognitive, and behavioural symptoms.⁽⁴⁾

Stress is a condition in which the mind responds to events through biochemical processes that occur throughout the body. Literature also offers a finer classification of the type of stress based on its progression: positive, tolerable, and toxic.⁽⁵⁾ Positive stress leads to minimal changes in the body. Tolerable stress is more impactful, but of a relatively short duration, while toxic stress is experienced when the individual has to deal with adverse circumstances for a protracted period.

When stressed, the individual moves from homeostasis (stability and balance in all the physical systems) to the sympathetic nervous system — the ‘fight or flight’ response, which manifests in increased heart rate, blood pressure, and breathing rate, coupled with dilated pupils, decreased motility (movement) of the large intestine, constricted blood vessels, and increased perspiration.⁽⁶⁾ When this stage becomes prolonged, the individual may suffer burnout, which could become chronic, leading to poor physical and mental health.⁽⁷⁾

Physical manifestations of stress

Physically, chronic stress causes inflammation of the vascular system (particularly coronary arteries, leading to heart attacks); it may alter cholesterol levels, adversely impacts the immune system (which can be destroyed by the stress hormone corticosteroid) and digestive system, and causes excessive stimulation of the sympathetic nervous system.

This depletes the body of, amongst others, neurotransmitters (the body’s chemical messengers), peptides (molecules that contain amino acids critical to a number of bodily functions such as digestion, energy use, hormone functioning), and cofactors (molecules needed by enzymes in order to function), resulting in a negative impact on functioning.⁽⁸⁾ Physical symptoms of distress include, amongst others, fatigue, headaches, body aches and pains, gastrointestinal problems, sexual dysfunction, insomnia, and frequent colds and infections.

Emotional, cognitive, and behavioural manifestations of stress

Emotionally, toxic stress leads to mental exhaustion, distancing (including cynicism) from work and co-workers (also referred to as ‘depersonalisation’), and feelings of professional inefficacy.⁽⁹⁾ Irritability, anxiety, and a low mood are emotional symptoms frequently associated with chronic stress, while behavioural symptoms include changes in appetite, alcohol consumption, social withdrawal, procrastination, and avoiding responsibilities. In the work setting, distressed employees often display poor concentration, forgetfulness, difficulty taking decisions, and a negative frame of mind — both about the environment and the self. Chronic distress can cause or exacerbate mental health conditions such as anxiety disorders and mood disorders, necessitating professional medical intervention.

Working women and stress

Women globally are more likely than men to be employed in low-paying (e.g., clerical) and vulnerable jobs (e.g., self-employment).⁽¹⁰⁾ In addition, women, globally, still perform the largest share — three quarters — of unpaid household work.⁽¹¹⁾ They are also in the majority amongst shift workers and contract workers. They are often employed in jobs that require high involvement and entail long working hours, and many women work multiple jobs.

Organisational factors leading to distress include work overload, emotional labour (prevalent in customer-facing positions where the employee has to restrain personal emotions), lack of autonomy, inadequate supervision and managerial support, perceptions of injustice, and perceived lack of co-worker support.⁽¹²⁾

Another important factor is individuals’ locus of control — the extent to which they believe they have control over their circumstances. Those with an internal locus of control view themselves as in control of events and circumstances, while those with an external locus of control feel powerless.⁽¹³⁾

Stress is further exacerbated by overtime work, to which one in five women is subjected. Half of the women in the Deloitte survey who typically worked only their contracted hours described their mental health as ‘good’, compared to only 23% of those who regularly worked extra hours. Regular overtime work also has a negative impact on loyalty to employers, motivation, and productivity.⁽¹⁴⁾

Studies have shown that more women than men are reporting increased perceived stress levels.⁽¹⁵⁾ Schmaus et al.⁽¹⁶⁾ (2008) found that this could be attributed to a greater vulnerability of women when exposed to repeating stressors. Women also tend to use coping strategies aimed at changing their emotional response to stressful situations, while men tend to use more problem-focused methods of dealing with stress. Emotion-focused coping skills include self-distraction, emotional support, instrumental support, and venting. These emotion-focused coping mechanisms typically bring short-term relief from stress, but often do not result in situational change, i.e., resolution of the stressor.⁽¹⁷⁾

How big is the problem amongst South African women?

There is a dearth of recent national studies on women and stress in South Africa. The most recent national study on the prevalence of mental health disorders in South Africa, the South African Stress and Health (SASH) study,⁽¹⁸⁾ is now two decades old. This survey found the lifetime prevalence of any mental health disorder to be 30.3%, with anxiety disorders the most prevalent (15.8%), followed by substance-use disorders (13.3%) and mood disorders (9.8%). A slightly more recent survey by Stein et al.⁽¹⁹⁾ found the 12-month prevalence estimate for common mental health disorders (anxiety, mood, and substance-use disorders) to be 16.5%, which is relatively high when compared to international prevalence estimates such as those reported by the World Mental Health Survey.⁽²⁰⁾

A recent South African survey⁽²¹⁾ of 3 402 respondents found the prevalence of probable depression to be 25.7%, while 17.8% reported probable anxiety. Finally, according to the fourth Annual Mental State of the World Report 2023,⁽²²⁾ based on 419 175 responses from 71 countries, South Africa ranked 69th in mental well-being, with a 35% increase from 2022 in individuals in distress or struggling. Factors contributing to the causation and exacerbation of mental illness in South Africa include poverty, unemployment, inequality, violence, gender-based violence, and political upheaval, both in the past and currently.

Despite significant advances, women still encounter a range of unique challenges in the workplace. A recent analysis of income data in South Africa showed a disconcerting increase in the gender pay gap. In 2021, women in South Africa earned 78 cents for every rand earned by men, compared to 89 cents in 2008.⁽²³⁾ Furthermore, workplace harassment and discrimination continue to undermine the progress of women in the workplace. The Deloitte report⁽²⁴⁾ also highlights threats to women’s safety while commuting to and from work, and in the workplace, with 10% reporting harassment during their commute and 43% reporting harassment and micro-aggressions at work during the previous year. Despite the high prevalence of these experiences, more than one-third of these women chose not to report the incidents, either considering the incidents not severe enough to report, or due to concerns that the behaviour would get worse, while others feared that reporting incidents would jeopardise their career. A recent KPMG report⁽²⁵⁾ notes that psychological safety at work, an openness to mental health discussions, and flexible work conditions contribute to less stress at work. Unfortunately, a mere 5% of women reported working in such positive environments.⁽²⁶⁾

The situation in South Africa comports with the findings of international studies. Although Deloitte’s 2024 Women @ Work report⁽²⁷⁾ indicated a decrease in burnout, half of the survey respondents reported experiencing higher stress levels than in the preceding year, and a third had taken time off work due to mental health challenges. Furthermore, most women said they did not receive adequate mental health support at work, while two-thirds indicated that they did not feel comfortable disclosing or talking about mental health difficulties. Some of the reasons cited for the reluctance to disclose were concerns regarding their career progression, discrimination, job security, and previous negative experiences due to having disclosed their mental health difficulties. The Deloitte Report⁽²⁸⁾ further highlights that women being disproportionately burdened with childcare and domestic chores exacerbates their stress, with a significant impact on their mental health.

The negative impact of (dis)stress on productivity and organisational outcomes is significant. Stress-related symptoms can contribute to absenteeism, staff turnover, and tardiness, and may lead to negative peer relationships, a decline in quality of work, disengagement, presenteeism, and, ultimately, burnout. In a study of eight countries, Evans-Lacko and Knapp⁽²⁹⁾ found the annualised population-level estimates of productivity costs of depression associated with absenteeism to be 0.62% of the GDP; for presenteeism, the productivity costs were 4.23%. Unaddressed stress therefore not only impacts the individual — and women disproportionately so — but also the bottom line of organisations and, ultimately, the economy.

A recent study by Bui et al.⁽³⁰⁾ (2021) supports previous literature indicating gender differences in stress at work. Women with supportive co-workers and supervisors were found to experience less work stress than men, with a definitive increase in the stress levels of women in poor supervisor relationships. Women also tend to value relationships, recognition, and respect at work, while men tend to place greater value on remuneration and achievement.

Although the physical, emotional, behavioural, and cognitive symptoms of stress are similar in men and women, women are more prone to headaches and migraines, irritable bowel syndrome, obesity, fertility problems, menstrual disorders, and decreased libido. Women are more prone to internalising emotional distress, which is then often not heeded, but which ultimately finds expression in bodily symptoms, while men are more prone to externalising distress, evident in, e.g., substance misuse, irritability and aggression, and escapism (e.g., watching pornography).

Prolonged stress can lead to burnout

Although the Deloitte report⁽³¹⁾ indicates a decrease in burnout, it remains a significant problem. Burnout is a state of emotional, mental, and often physical exhaustion brought on by prolonged or repeated stress. It is a workplace phenomenon that should not be confused with daily stressors of everyday personal-life responsibilities.

Burnout at work is defined by the World Health Organization⁽³²⁾ as “a syndrome conceptualized as resulting from chronic workplace stress that has not been successfully managed”. It is characterised by three dimensions: feelings of energy depletion or exhaustion; increased mental distance from one’s job, or feelings of negativism or cynicism related to one’s job; and reduced professional efficacy.

The cause is usually an imbalance between job demands and resources, i.e., what is expected of the individual at work versus the availability of time, finances, training, support systems, mentorship, and other resources. Another contributing factor to the development of burnout is conflicting values: either a mismatch between the employee’s personal values and the organisational values, or a mismatch between the officially stated values of the organisation and the values in action.⁽³³⁾

Burnout is not a medical disorder. By the time individuals seek support for what they consider burnout, they are usually already fulfilling the criteria for an anxiety disorder or a depressive episode. It is therefore crucial that women are not told to ‘get some rest’ or be booked off for extended periods, but that professional support from a healthcare practitioner is sought and an active management plan is put in place to prevent the complications of untreated mental health disorders.

Strategies for addressing workplace stress in South Africa

Prevention is better than cure. It is crucial that organisations address and reduce stressors that affect women disproportionately in the workplace. First and foremost is the role of leaders in creating psychological safety, together with an environment in which mental health problems are not stigmatised and mental well-being is supported. Ensuring that organisational policies reflect the importance of women’s health, both physical and mental, is crucial. Raising awareness through educational activities and establishing accommodating practices at work that enhance work–life boundaries will enable women to fulfill their other roles (e.g., childcare, parental care, and household chores) while also being able to tend to self-care (through, e.g., sufficient sleep and exercise). Supporting women thus entails timeously recognising ‘red flags’ indicating mental health difficulties.

Employee wellness programmes should focus on the following warning signs:

• Depressed mood
• Anxiety and irritability
• Changes in sleeping patterns (insomnia or hypersomnia)
• Changes in appetite (either loss of or increased appetite)
• Negative thoughts about self or life
• Feelings that life is not worth living or thoughts of self-harm or suicide
• Loss of interest, drive, and joy
• Social isolation
• Increased use of substances (e.g. painkillers, sleeping tablets, and alcohol)
• Inexplicable physical symptoms of ill health
• Inexplicable fatigue

Encouraging women to access professional support without fear of discrimination will help prevent eustress from becoming distress and, ultimately, burnout. Unsafe and non-inclusive workplace environments where women fear for their physical safety and experience harassment and bullying should be eradicated, and it should be made clear that such behaviour will not be tolerated. Deloitte⁽³⁴⁾ further recommends embedding family-friendly benefits and policies, focussing on work–life balance, and tailoring return-to-work policies (whether from remote work to in-office work, after maternity leave, or after absenteeism due to mental health disorders or physical illness) to accommodate the specific needs of women.

Women should be active participants in their own health through self-care, seeking social support and accessing professional intervention when needed. These efforts should also be aimed at the development and strengthening of an internal locus of control.

A nutritious diet, in combination with mindful eating, is important in combatting stress. Sugar and refined carbohydrates elevate blood sugar levels, which increase anxiety and stress. Stress ‘uses’, and thus reduces, the levels of certain nutrients in the body: B vitamins (metabolic functioning and a healthy nervous system), proteins (tissue repair), vitamin A (vision function), vitamin C (immune system health, and reduces hydrocortisone), and magnesium (development of fatty acids and heartbeat regulation). It is also important to exercise regularly.⁽³⁵⁾

Conclusion

Despite some progress in recent years in corporate mental health awareness and interventions, women’s stress levels have continued to rise, and stigmas around workplace mental health persist. Women face unique and additional challenges in and outside the workplace, including inequality, discrimination, and unsafe environments, as well as a disproportionate additional load in the form of child- and parental care and domestic responsibilities. It is thus vital that organisations prioritise women’s health in the workplace by ensuring psychologically safe spaces where women are included and supported, allowing them to thrive in their careers.